Mortality from arterial hypertension in the regions of the Russian Federation in the period from 2013 to 2019.

Aim      To analyze the dynamics of mortality from arterial hypertension (AH) between 2013 and 2019.Material and methods  Arterial hypertension (AH) is one of the most common diseases. At the same time, there are no unified international criteria for establishing the primary cause of death from AH. Data were studied for the period between the end of the program for modernization of health care and the start of the Federal Project "Program for combatting cardiovascular diseases". Data for 2013-2019 by AH-related codes were provided by the Federal Service of State Statistics on request via the C15 form, "Mortality by gender and one-year age groups". A standardized mortality ratio, its mean value, standard deviation, and a coefficient of variation were determined for each "cause". The standardized mortality ratio was calculated using the European standard.Results In Russia during the studied period, the standardized mortality ratio for the death from AH yearly decreased (1.7 times for 6 years; the standardized mortality ratio decreased 1.15 times). However, only in 7 regions, the standardized mortality ratio yearly decreased while in the other regions of the Russian Federation, the standardized mortality ratio changed wavily. In 17 regions of the Russian Federation, the standardized mortality ratio increased in 2019 compared to 2013, including the 31.7 time increase in the Republic of North Ossetia-Alania. In the Penza Region and the Republic of Kalmykia in 2018, there were no cases of death related with AH. The highest value of the standardized mortality ratio was observed in the Chukotka Autonomous District in 2019 (85.13 per 100,000 population) and the lowest value was observed in the Penza Region (0.14 per 100,000 population). The ratio of maximal to minimal values of the standardized mortality ratio was 622. The coefficient of variation for regional standardized mortality ratios increased by 42.3 % (from 86.8 to 123.5 %).Conclusion      Although the standardized mortality ratio for death from AH, in general, decreased in the Russian Federation, Russian regions showed variable dynamics and a high variability of the standardized mortality ratio. The study results together with results of international studies showed that differences in standardized mortality ratios for death from AH are largely due to different approaches to determining the primary cause of death. An international consensus on the terminology and criteria for determining the primary cause of death is required.

[Clinical and organizational assessment of endovascular care accessibility at the regional level].

The world health care system´s concern of inequalities in treatment of receiving the necessary medical care. The purpose of article to evaluate the availability of endovascular care (EVC) for patients at regional level in Russia and to develop a system for its improvement. As a result the low availability of EVC for the population at the regional level in Russia with coronary heart disease, atherosclerosis of the brachiocephalic arteries and critical lower limb ischemia (CLLI) was funded. The main reasons for the difficulties in obtaining EVC in the regions of Russia are the low frequency of diagnosing a critical stage of cardiovascular disease (CVD) requiring surgical treatment, the absence of cardiovascular surgeons and cardiologists in the medical care organizations, the failure in information to patients attending a regular doctor´s appointment about effectiveness and safety of endovascular treatment technology. More old-school traditional methods remain in place like bypass or endarterectomy surgery. Further obstacles are prolonged waiting list at the regional level for the provision of high-tech care in cardiovascular surgery, choice of conservative treatment methods or amputation of lower limbs for patients with CLLI 3 and 4 st. (p<0.05). In Conclusion the Clinical and organizational assessment of the endovascular care accessibility in CVD for the population in regions of Russia elaborated. One way to improve the situation is the introduction of the cardiovascular care clinical management. A dual-circuit clinical and organizational system was developed and proposed to increase endovascular care accessibility in regions.

[The comparative analysis of coefficients of variation of standard regional indices of mortality and causes having and having not accurate criteria of diagnostics].

The standardized mortality coefficients for different causes have significant variability between regions and depend on many factors. The purpose of study was to investigate interregional variation coefficients of standardized mortality of oncologic diseases as compared with other causes having no explicit diagnosis criteria. The 49 death causes were selected out of 295 causes of the Short nomenclature of the Rosstat. These causes were distributed by 2 groups: neoplasms and causes without explicit diagnostic criteria. The standard mortality indicator was calculated on the basis of the European standard. The significance of differentiations between the groups was estimated using one-factor dispersion analysis by pair comparison and Bonferroni amendment. The level of interregional variation coefficient of the standard mortality indicator from cancer was lower than from other causes with no explicit diagnostic criteria. Even the reasons of death from oncologic diseases which has no explicit criteria have the significantly less marked variation coefficient as compared to other two groups. There were reliable differences of the variation coefficients between the subgroup of oncologic diseases with precise location of tumor and the subgroup of oncologic diseases of other and non-explicit locations. The death causes due to "other diseases" and the death causes due to diseases with no-explicit diagnostic criteria had similarly high level of variation coefficient. The difference of the regional standard mortality indicator of concrete reasons is affected by uncoordinated criteria of diseases diagnostic and the main reason of death determination. The letter of the Minzdrav of Russia concerning the rules of application of notion "senility" as cause of death played certain role also. The different level of morbidity in regions had the influence as well. The harmonization of verification of all the cases of diagnosis, its "depth" and applied criteria is needed for proper analysis of data of death from separate causes is needed.

[comparative analysis of variability of mortality rates from various causes in the subjects of Russian Federation]. / Sravnitel'nyi analiz variabel'nosti pokazatelei smertnosti ot razlichnykh prichin v sub"ektakh Rossiiskoi Federatsii.

Mortality rates have significant differences between regions of the Russian Federation. Standardized mortality rates (SMR) are influenced by many factors, including diagnosis criteria and causes of death. AIM OF STUDY: Analysis of coefficient of variation of SMR from malignant neoplasms compared with other causes of death in the subjects of Russian Federation. MATERIALS AND METHODS: The study formed 3 comparison groups: malignant neoplasms, other causes and causes of death, presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules for its use, as well as unspecified and not recommended for use in mortality statistics. To calculate SMR out of 79 reasons selected from the «Brief nomenclature of causes of death of Russian Statistic Bureau (RosStat)¼, the European standard was used. The accuracy of differences between the groups was evaluated using one-way analysis of variance with pairwise comparison and Bonferroni correction. RESULTS: In the group of malignant neoplasms, there were significant differences in the coefficients of SMR variability between the subgroup of neoplasms with an exact indication of localization and the subgroup of malignant neoplasms of other and inaccurately defined localizations. However, even the causes of death from malignant neoplasms that do not have sufficiently clear application criteria have a significantly less pronounced coefficient of SMR variability compared to the other two groups. The causes of death, starting in the RosStat nomenclature with the words «other diseases¼, and the causes associated with the diseases presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules of its use, as well as unspecified and not recommended for use, had practically the same high level of SMR variability coefficient. A certain contribution to the differences in regional SMR indicators from specific causes can be affected by the inconsistency of the criteria for diagnosing diseases and choosing the initial cause of death. CONCLUSIONS: To obtain the correct indicators of mortality from individual causes / groups of causes, we need unified generally accepted definitions and rules for the application of conditions presented in ICD-10, which do not have clear diagnostic criteria, as well as unspecified; and as well as rejection of statistics not recommended for use because of the initial causes of mortality.

[The system of mandatory medical insurance as evaluated by patients].

The population awareness about merits of mandatory medical insurance (MMI) continues to be inadequate. The study purpose was to investigate opinion of Moscow Oblast residents about MMI system. The sociological survey was carried out according standard technique using specially developed genuine questionnaire. The public opinion was studied in 2013 (584 respondents) and 2017 (709 respondents) on the basis of sampling of visitors of medical organizations. The survey established that percentage of positive responses of respondents concerning their awareness about which medical insurance company they belong slightly increased in 2017. However, every thirteenth still was unaware of it. Only every sixth respondent addresses to insurance company when occur problems related to medical care support. The right to choose insurance company, medical organization and physician was used by 17-22% of respondents in both surveys. In 2013 20% of respondents addressed nowhere due to absence of problems with health services support. In 2017, number of addresses to administrations of medical institutions increased up to 35%. The number of addresses to insurance companies and MMI foundations increased up to 13% and 27% correspondingly. The percentage of respondents with positive answers about being constrained to pay for medical services unofficially decreased up to 18% in 4 years and reached 12,6% in all sampling. Thus, activities concerning population information about changes occurring in health care system, including development of citizen rights is inadequate still. The citizens in number of cases are not interested to obtain necessary information and ignore it down to name of insurance company mentioned on their insurance policy.

[The Impact of Medical And Non-Medical Factors on Population Mortality: Environment Factors].

The second analysis was implemented concerning results of study evaluating impact of environmental factors on indices of population mortality on the basis of hard copy and digital publications in Russian and English in 1990-2016. It is established that air pollution by tiny particles of different origin results in a reliable increasing of risk of premature death independently of level of economic development and geographical positioning of country. In European countries this occurrence conditions shortage of of life-span on 8-13 months. The industrial factors are a cause of about 30% of involuntary occupational traumas. The limitation of access to clear drinking water specific to developing countries conditions death of more than 3 million people annually. The impact of waves of cold and heat on mortality depends on particular region, their duration and intensity, level of economic development of country, social economic conditions and age of particular groups of population and is estimated in 1-16% of additional deaths. The global climate warming is associated with decreasing of level of mortality. the negative impact of environment is increased by residing in underdeveloped regions, lower social economic status, lower level of education, population density, shortcomings of architecture and public space, the factors of environment play a significant role in population mortality. As regards their impact an uncertainty exists: it is quite difficult to separate an impact of single factor. So, different approaches are applied in different studies.

[The Impact of Medical and Non-Medical Factors on Population Mortality: the Social Factors].

The study was carried out to analyze national and international publications evaluating impact of social factors on population mortality. The analysis was made on the basis of publications accessible in prints and electronic format (MEDLINE, EMBASE, ISI Web of Science) in Russian and English from 1990 to 2015. The results of generalized studies testify a valuable impact on standardized mortality coefficients of such factors as social support and social integration, higher level of education, higher social position, global peacefulness index, developed infrastructure. The negative impact is made by social stress, lower level of education, higher level of unemployment, social deprivation. It is established that social factors are ones the main factors effecting population mortality level. The effect of social factors is ambivalent and heterogeneous in time and by population groups. he quantitative evaluation of effect of every one of social factors is difficult.

[THE MORBIDITY OF POPULATION OF THE RUSSIAN FEDERATION: GEOGRAPHIC CHARACTERISTICS].

The article considers the results of analysis of characteristics of morbidity of population residing in various geographic conditions of the Russian Federation. The comparison was applied to morbidity of residents of subjects of the Russian Federation residing approximately at the levels of 50 and 60 of northern longitude according data of 2008-2013. The average annual size of population of the Northern territories amounted to 8,994,112 and in the southern territories 32,600,569. The maximal differences are noted in relation to diseases of respiratory organs and congenital abnormalities of blood circulation system. Actually, indicators of morbidity of diseases of cardiovascular system and ischemic heart diseases had no differences. The rest of analyzed indicators differed on 10-40% towards higher values in the Northern regions. The exception included cerebrovascular diseases with morbidity higher in southern territories up to 11% than in northern territories.

[The mandatory medical insurance through eyes of medical personnel].

The article considers the results of sociological survey carries out among medical personnel of the Moscowskaya oblast in August-September 2013. The purpose of the study was to examine opinions of medical personnel about system of mandatory insurance in conditions of implementation of the new law regulating system of mandatory medical insurance during last three years. The sampling included 932 respondents that corresponds approximately 1% of all medical personnel in the oblast. It is established that even 20 years later after the moment of organization of the system of mandatory medical insurance not all medical personnel is oriented in it. More than 70% of respondents consider this system too convoluted and over bureaucratized and only 22.2% of respondents assume that medical insurance organizations defense interests of patient and 25.8% feel no impact of mandatory medical insurance funds on functioning of medical organizations. Most of respondents consider functions of mandatory medical insurance organizations and mandatory medical insurance funds as controlling only. Only 31% of respondents support the actual system of mandatory medical insurance.